ABSTRACT
How can a provider be reasonably sure that a woman is not pregnant, or just about to be pregnant in a conception cycle? WHOSPR advises that the provider can be reasonably certain that the woman is not pregnant if she has no symptoms or signs of pregnancy and one or more of the following criteria apply:
1. She has not had intercourse since last normal menses 2. She has been correctly and consistently using a reliable [sic]
method of contraception 3. She is within the first 7 days after (onset of) normal menses 4. She is within 4 weeks postpartum for non-lactating women 5. She is within the first 7 days post abortion or miscarriage 6. She is fully or nearly fully breastfeeding (as in LAM – Figure 19,
p. 143), amenorrhoeic and less than 6 months postpartum. Note: Good clinical judgement is vital with respect to assessing the accuracy of the given history, including: • the absence of symptoms of pregnancy • the believability of reported abstinence • especially regarding point 2 in the list, reliability of reported
correct condom use is notoriously difficult to assess. In the UK, as appropriate, these criteria can be backed by a urine pregnancy test with a sensitivity of at least 25 IU/l, best on a concentrated early morning sample. Such tests are unnecessary and wasteful if there could not possibly yet be an implanted blastocyst present – including, for example, at the time of most requests for EC (e.g. in pill-takers when pills have just been missed).
